20160187 Permit Pkg 04112016City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name. CLAUDIA SHEPHERD
Address: PO BOX 1215
YELM WA 98597
Property Information:
Site Address: 404 FIRST ST S
Assessor Parcel No.: 22719332300
Contractor Information:
Name: CLAUDIA SHEPHERD
Address:
PO BOX 1215
YELM WA 98597
Contractor License No.:
Project Information:
Project: SIGN
Description of Work: SIGNAGE
Sq. Ft. per floor: First
Second
Third
Garage
Basement
Fees:
Item
SIGN
Permit No.: 20160187
Issue Date: 0 100 /0000
(Work must be completed within 180 days)
Phone: 360- 259 -7777
Owner: TYPE CURRENT OWNER
NAME
Subdivision: N/A
Phone:
Expires: 0 /00 /0000
Heat Type (Electric, Gas, Other):
Contractor
CLAUDIA SHEPHERD
TOTAL FEES:
Applicant's Affidavit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I further certify that I am currently
registered in the Sta��f�A(ashington.
Signature( >'/ I _.- -.._.. Date
Firm
Lot: N/A
Fees
$ 125.00
$ 125.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Mi
(36 ) 458 -3244
REC #: 00227890 4/11/2016 11:49 AM
OPER: CO TERM: 001
REF #:
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20160187 125.00CR
SHEPHERD, CLAUDIA
404 FIRST ST S
SIGN 125.000R
TENDERED: • 125.00 CASH
APPLIED: 125.00 -
CHANGE: 0.00
CITY OF YELM
SIGN PERMIT APPLICATION FORM
Project Address: f2/� �s f �I l 4 />vX4" 4 Parcel #:
Zoning; 402�22' /Qg Current Use:_ Proposed Use:
f��G
Type /Number of Sign(s) (wall, monument, lighted, etc.):
Value of each Sign:
Dimensions of Sign(s): 6;;�/
Building Gross Floor Area (sq. ft):
Building Height:
Existing Signage (if any) and dimensions:
APPLICANT Gc
La§L ame First Name
ADDRESS � r EMAIL co"
CITY �kj,,..t. STATE ZIP TELEPHONE i% _
El
11
BUILDING TENANT a
ADDRESS f 1 EMAIL Y C_ h i v co. r
CITY STATE ZIP TELEPHONE 3 ®, ?
SIGN CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
I hereby certify that the above information is correct and that the construction of the above described sign will be in
accordance with the laws, rule gulations of the State of Washington and the City of Yelm.
Applicant' gn ur Date
Owner/ ontractor / Owner's Agent/ Contractor's Agent/ Tenant (Please circle one.)
All permits are non - transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Ave W W16r9ro 438- 38Vr.. " " " " "'
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.yelm.wa.us
C.
1�
r.
PAI
J
Q Q
d
W �
Z
L /
r
m